When it comes to screening and modifying risk for diabetes and cardiovascular disease, research on epicardial fat is getting to the heart of the matter. This organ-specific fat has a unique genetic profile and dictates important local and systemic effects throughout the body.

Recognizing the importance of this line of research, the European Society of Cardiology recently invited Gianluca Iacobellis, M.D., Ph.D., professor of clinical medicine in the Department of Medicine’s Division of Endocrinology, Diabetes and Metabolism at the University of Miami Miller School of Medicine, to speak at their conference.

Iacobellis was one of five speakers from around the world who provided updates during a “Crosstalk Between Adipocytes, the Heart and Coronary Vessels” session at the Frontiers in Cardiovascular Biology 2018 Congress in Vienna, Austria.

He shared the highlights of a decade and a half of innovative research into the role and promise of epicardial fat.

“It was very nice because each speaker started their presentation by recognizing my work, which was very flattering,” said Iacobellis, who is also director of the UHealth Tower Diabetes Service.

Work by Iacobellis and others demonstrates that epicardial fat is distinguished from other visceral adipose depots throughout the body.

“It’s unique not only because of the anatomic location, but also because when I started looking at genetic, molecular and clinical features, I found these fat cells are unique in terms of gene expression and molecular properties. This has strong clinical implications.”

Obesity in general has been associated with elevated risk for diabetes and heart disease for a long time, and fat around the waist, in particular, has been implicated more recently. But now researchers are diving deeper and discovering the unique and important role that organ-specific fat plays in driving these risks.

Iacobellis developed a technique to measure the cardiac tissue using simple, standard cardiac ultrasound. He demonstrated an ability to measure the thickness of the fat and predict the cardiometabolic risk in patients with diabetes or other high-risk populations in a 2013 study published in the American Journal of Cardiology.

“Lately, I found the ultrasound thickness of the tissue is an excellent and very responsive therapeutic target,” he said. “There are medications that directly or indirectly target the epicardial tissue.”

The fact that this fat tissue is inside and around the heart is also significant. “My research also showed that there is cross talk between the epicardial fat and the fat actually inside the heart cells,” said Iacobellis.

Epicardial fat is a modifiable risk factor, which makes it appealing for both science and clinical research, he added. Now this fat can potentially be manipulated with pharmaceutical agents. For example, liraglitude plus metformin reduced epicardial fat by more than one-third after 24 weeks in a clinical trial, Iacobellis and his team reported in an article in the journal Obesity in 2017. In the same report, they also compared the two agents and found that liraglitude reduced epicardial adipose tissue to a greater extent than did metformin.

“There are medications that can reverse the fat from being an enemy to being a friend of the heart,” said Iacobellis.

Sitagliptin and dapaglifozin, he noted, are additional agents that show promise for reducing epicardial fat.

Iacobellis is grateful for the support for his research that he has received from the Department of Medicine and the Division of Endocrinology.

“These studies could not be completed and be so successful without the help of UM — it’s very interdepartmental research,” he said.

In fact, he has been collaborating in other research with the Dr. John T. Macdonald Foundation Department of Human Genetics, the Cardiovascular Division and the Division of Cardiothoracic Surgery.

Going forward, Iacobellis would like to further evaluate the direct role of epicardial tissue in coronary artery disease, evaluate how medications for diabetes and heart disease can target this fat tissue, and investigate the possible association between epicardial tissue and atrial fibrillation.